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General NPI Number Information
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NPI Number | 1104490671
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Entity Type | Organization
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Legal Business Name | SYNOVATION MEDICAL GROUP TEXAS, PLLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1518 10TH ST
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City | WICHITA FALLS
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State | TX
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Zip | 76301-4405
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Country | US
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Telephone | 940-253-7160
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Fax | 833-460-5681
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Provider Business Mailing Address
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Address Line | 10565 CIVIC CENTER DR BLDG STE 250
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3853
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Country | US
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Telephone | 626-696-1481
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Fax | 626-696-1451
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Authorized Official
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Title or Position | MANAGER-MEMBER
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Name | CLAYTON ALEXANDER VARGA
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Credential | MD
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Telephone | 305-428-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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